Social Prescribing Dr Patrick Hutt (Queensbridge Group Practice) City and Hackney Social Prescribing GP Lead

Overview Background What’s been happening in Hackney? Consortia Pilots I-Care Social Mapping Exercise Evaluation

London Life expectancy decreases from west to east

The Inverse Care Law “The availability of good medical care tends to vary inversely with the need for it in the population served….” Tudor Hart, Lancet 1971

Wealth of Epidemiological Data Black Report 1980 Acheson Report 1998 Marmot Review 2010

Poverty of progress? All reports similar findings & advocate similar actions: Early Years/Childhood Education, Training, Jobs Housing Cross –governmental action Bambra C et al. A labour of Sisyphus? Public policy and health inequalities research from the Black and Acheson Reports to the Marmot Review. JECH, 2010 Centre stage -

What is the role of General Practice?

The Deep End ‘Single woman in her 30s asked to do work of several staff at supermarket due to cutbacks. Can’t cope, stressed, makes looking after three teenage school kids with behavioural problems harder. Attends emergency surgery crying +++. Doesn’t know who to turn to so comes to GP. Long, unscheduled, consultation.’ Deep End, 2012

Tackling Health Inequalities: Strengths of UK General Practice Generalist Approach GPs at the heart of the community Strong tradition of GPs seeking social change to improve health IT system that allows population data to be linked to consultations Kings Fund (2010) MENTION CONSULTATION DATA

Centre Of The Community GPs know their population Well placed to sign post patients GPs are aware of local organisations GPs are trusted Able to work together with community groups to tackle local issues FORTUNATE MAN PICTURE INSERT

Picture Quiz

Challenges To This Idea GPs don’t know their local population Community and Voluntary Organisations find GPs unapproachable, ‘too busy’ Rapid Turnover of Projects Directories are not up to date Clinical pathways don’t utilise the potential of local organisations ? Hard to re-create Bromley by Bow

Social Prescribing City and Hackney CCG GPs facilitating better linking between patients and community organisations

Positive Benefits Reduction in symptoms (anxiety and depression) Social Benefits (inclusion, participation, access to new networks) Practical and material Benefits (debt, housing, benefits) Skills (employment) Quality of Life (reducing isolation, loneliness, lack of confidence and self esteem) Friedli et al, 2009

Comments from Dundee ‘I think so yeah [recommending the scheme], if they were sort of in a rut and that, aye…’ (patient) ‘Some patients say they are simply not v good at speaking. I say: ‘this isn’t traditional counselling – simply looking at where you are now, what things are out there that would sit well with your interests to compliment your life.’ (GP) Friedli et al Sept 2012, Dundee

City and Hackney CCG Project Aims to enable individuals feel more in control, have improved self-esteem and confidence, and self-report an improvement in health and well-being to reduce social exclusion GPs and their teams become more aware of what’s happening in the community and vice versa to support individuals to visit the GP or hospital less as they are managing /coping better to improve sense of community well-being – mutual support

Pilot project timetable : Phase 1 Planning and development (key stakeholder engagement and multi-agency project steering and task groups) March -September 2013 1. GP Consortia identified 2. Service model agreed 3.Service provider agreed Phase 2 Mobilisation October 2013- December 2013 1. External evaluation provider to be identified 2. Community mapping completed 3. GP Consortia and providers agree referral model and publicity Phase 3 “Going live” January 2014 - March 2015 1. Patients referred to social prescribing project 2. Service monitored and evaluated

Pilot project model GP practices in the 3 consortia test sites will: Refer patients to a local community activity s/he is aware of and also give patients the option of a referral to a social prescribing co-ordinator for a full assessment and social prescription (using LBH I-Care Well-being Plan). The patient will also receive a social prescribing (telephone follow- up) with GP practice and a final report from the social prescribing co-ordinator. Feedback from co-ordinator to GP – 8weeks Children’s Centres Icare and a local service direct referral e.g. lunch club e.g. tea dances social prescribing co-ordinator(s) GP practices e.g. Befriending service

Three Pilot Consortia Rainbow and Sunshine Consortium South West Consortium Well Consortium

Hackney and City CCG Target Groups socially isolated/withdrawing presenting with a social problem struggling/not coping, but do not require crisis intervention ( may have noticed an increase in GP visits) asking for “low-level” non-clinical activities to help them feel better Diabetics/Isolated Elderly Population

I – Care Website www.hackneyicare.org.uk

Evaluation Important that we gather evidence Academic tender underway Please participate where possible Survey in circulation – please ask colleagues to complete also

Summary Social prescribing is coming to a consortia near you! All practices have access to ICARE – please encourage others to use (it can help!) Evaluation will be underway Comments, questions, or suggestions – please email sandracater@nhs.net

“Give me a place to stand on, and I will move the world” Mechanics Magazine, Knight and Lacy, 1824

A GP is a Team Player

Primary Care – Now More Than Ever! Improving Health Is A Team Effort Primary Care – Now More Than Ever!

Thank you for listening! Comments/Questions